Fertility problems

Some cancers or their treatments affect the reproductive system, which can lead to fertility problems. If the reproductive system is damaged, it can affect a man’s ability to father children or a woman’s ability to become pregnant. Infertility, or the inability to conceive a child, can be a concern for some people after treatment is finished.

The types of fertility problems that can develop, and whether or not they are temporary or permanent, depend on:

your age

the type of cancer

the type or dose of treatment

the length of time since treatment

Causes

Fertility problems can be caused by different cancer treatments.

Surgery

Some surgeries for cancer can cause permanent infertility.

In men, the testicles make sperm and the male sex hormones. The prostate is a gland that makes fluid that, along with sperm, forms the semen. Removing 1 testicle shouldn’t affect a man’s fertility. But if both testicles are removed, the man’s body can’t make sperm. If the prostate is removed, the man’s body can’t make any semen. Surgery can sometimes damage the nerves that supply a reproductive organ such as the penis or prostate. This damage can cause erectile dysfunction, or impotence.

In women, the ovaries make eggs and the female sex hormones. The uterus, or womb, contains and nourishes a baby during pregnancy. If both ovaries are removed, a woman’s body can’t make any eggs and she won’t be able to have a baby. If the uterus is removed, there is nowhere for a baby to develop and grow.

Radiation therapy

Radiation therapy to the pelvis or reproductive organs can cause temporary or permanent fertility problems. The more radiation the testicles or ovaries are exposed to, the greater the chance that infertility will be permanent.

Radiation to the testicles can lower the number of sperm and affect a sperm’s ability to function normally. Radiation for prostate cancer may cause erectile dysfunction, or impotence.

Radiation can cause permanent damage to a woman’s ovaries. This can lead to treatment-induced menopause and a permanent loss of reproductive function. Find out more about treatment-induced menopause.

Radiation therapy to the area of the brain that includes the pituitary gland can sometimes affect fertility. The pituitary gland makes hormones that stimulate the ovaries to make eggs and the testicles to make sperm.

Chemotherapy

Some chemotherapy drugs or combinations of drugs can damage the ovaries or testicles. Whether or not chemotherapy affects fertility, and whether the effect is permanent, depends on the type, dose and number of drugs used. In general, alkylating drugs have the most damaging effects on fertility.

Many chemotherapy drugs can affect the testicles so they make less sperm. These drugs can also damage sperm cells so they don’t function normally.

Most chemotherapy drugs can affect a woman’s menstrual cycle so that she stops ovulating. This can result in premature menopause, which can be temporary or permanent depending on the woman’s age.

Although chemotherapy drugs can damage eggs and cells that make sperm, their effects on fertility may not be permanent. The reproductive cells may continue to function when treatment is finished and the person’s fertility may return. Younger men and women usually have a better chance of regaining their fertility. Women younger than 35 years of age are more likely to have their periods come back and remain fertile. The older a woman is, and the closer she is to natural menopause, the greater the chance that infertility will be permanent.

Hormonal therapy

Some hormonal therapies may block the effects of hormones involved in reproduction. This can affect fertility. Some women may go through natural menopause while taking hormonal therapy. Menstrual periods usually come back a few months after hormonal therapy stops.

Diagnosis

If you have fertility problems after your cancer treatment is finished, your doctor will do a physical exam to find out what is causing them. Your doctor will also ask questions about your health history and treatments you’ve received.

Managing fertility problems

Talk to your doctor about the effects cancer treatment can have on your ability to have children, as well as your fertility and parenthood options. Fertility counselling should be done before treatment starts. Counselling includes discussing:

available options

which options may be best for you

possible future outcomes

costs of different options

Different medical procedures can be used to help prevent infertility or help couples conceive. These procedures may be called assistive reproductive technology (ART). The rates of a successful pregnancy vary depending on the method used. Some of the options given below may not be available in all provinces. Check with your provincial or territorial health insurance plan about which fertility options are covered.

Radiation shielding

When possible, the healthcare team will try to shield or protect the testicles in men and the ovaries in women during radiation treatments. This may help preserve fertility. Whether this will be possible or not depends on the type and location of the cancer.

Some women may have surgery to move the ovaries out of the radiation field before radiation therapy. They may be moved behind the uterus or closer to the pelvic bones. Moving the ovaries out of the treatment area may protect them from the damaging effects of radiation.

Sperm banking

Sperm banking may be an option for some men who wish to father children in the future. Sperm is collected and frozen before treatment starts. The sperm is stored for future use in fertilization procedures known as artificial insemination.

In vitro fertilization (IVF) uses the man’s sperm to fertilize the woman’s egg in a test tube in the lab. The fertilized egg is later implanted into the woman’s uterus.

Intracytoplasmic sperm injection (ICSI) injects a single sperm into a single egg. The fertilized egg is later implanted into the woman’s uterus.

Banking or freezing eggs

Banking or freezing eggs is also called oocyte banking or cryopreservation. Some of a woman’s eggs are removed from her ovaries and frozen. The eggs are later thawed and then fertilized with a man’s sperm. By 2009, more than 900 live births using frozen eggs had been reported world-wide.

The type of cancer, how quickly cancer treatment needs to be started and other factors may mean that egg banking or freezing isn’t an option.

Before the eggs are collected, the woman usually has to take hormones. These hormones increase the level of estrogren in the body, which can increase the number of mature eggs available for collection. Doctors may be able to collect 1 or 2 eggs without giving hormones, but having only this small number of eggs may lower the chances of a successful pregnancy.

Some women can’t take hormones before egg collection because they have a hormone-dependent type of cancer, such as breast cancer. This means that hormones can make the cancer grow. For example, the hormone pill clomiphene citrate (Clomid, Serophene) is usually offered, but it may cause hormone-dependent cancers to grow. Women with hormone-dependent cancers may also be offered letrozole (Femara). This drug may be given with or without other hormone pills. Both clomiphene citrate and letrozole stimulate the ovaries to help eggs mature, but letrozole helps prevent the high levels of estrogen in the body from causing cancer cells to grow.

Sometimes cancer treatment has to be delayed so that there are enough eggs available for collection. A larger number of eggs available increases a woman’s chances of getting pregnant in the future. Treatment may be delayed 2 weeks to prepare for egg collection and to collect the eggs for banking or freezing. Women who have to start cancer treatment as soon as they are diagnosed may not be eligible for egg banking or freezing. Young women who have reached puberty should be offered the option of banking or freezing their eggs before cancer treatment begins to preserve their fertility.

Some clinics will only offer egg banking or freezing to women within a certain age range. This is because younger women have more, and likely healthier, eggs. Different clinics may use different age ranges.

Unfortunately, eggs don’t freeze well. Not all the eggs that are frozen will survive the thawing process and can be fertilized with sperm. Recently, doctors have started to use a fast-freezing technique called vitrification. This process causes less damage to the eggs.

Banking or freezing eggs doesn’t result in as many successful pregnancies as banking or freezing embryos. But freezing eggs can be an option for women who don’t have the option of freezing embryos. This can include women without a male partner or women who don’t wish to use donor sperm.

Embryo freezing

Some people may want to look at the possibility of storing fertilized embryos. The woman’s eggs are collected during a surgical procedure and then fertilized with the man’s sperm. The fertilized eggs are then frozen and stored, or cryopreserved. The stored eggs may be implanted in the woman’s uterus at a later date.

Hormone injections are often used to increase the number of mature eggs available for collection. The type of cancer, how quickly cancer treatment needs to be started and other factors may mean that embryo freezing isn’t an option.

Other parenthood options

You may wish to look into the following parenthood options. You may also want to check with adoption agencies or seek legal advice on adoption or surrogacy.

Adoption

Having cancer doesn’t rule out the possibility of adoption. Some agencies may require that you wait for a certain amount of time after treatment before you can adopt a child. Agencies may also require your doctor’s approval.

Surrogacy

A surrogate is a woman who carries and bears a child for someone else. Some women may consider using a surrogate if their uterus is removed because of cancer and they can’t bear children themselves.

Using donor sperm or eggs

Some couples choose to use donor sperm or eggs in artificial insemination. The egg donor may be anonymous or known to the couple. Sperm donors are mostly anonymous and only frozen sperm are used.

Research in fertility options

Researchers are looking for new and better ways to help people have children after cancer and cancer treatment. Find out more about research in fertility options.